Renal effects of dual renin–angiotensin–aldosterone system blockade in patients with diabetic nephropathy

Vestra, Michele Dalla; Simioni, Natalino; Masiero, Alessandra

doi:10.1007/s11255-008-9490-0

Cited by 11 publications

(6 citation statements)

References 54 publications

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“…The CHEP 2009 recommendation advised against combination of an ACEI and ARB for patients with non‐proteinuric chronic kidney disease or in patients with diabetes and normal urinary albumin levels (Campbell et al ., 2009). Overall, although evidence from previous short‐term studies indicates that combined therapy with ACEI/ARB reduced proteinuria, there was no evidence of a beneficial effect of ACEI/ARB on progression of DN, and combination therapy resulted in a clinically significant decrease in GFR in some studies (Dalla Vestra et al ., 2009).…”

Section: Combination Therapy Of Acei and Arbmentioning

confidence: 88%

Renin–angiotensin–aldosterone system blockade for cardiovascular diseases: current status

Terry

Kam

Yan

et al. 2010

British J Pharmacology

307

200

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Activation of the renin-angiotensin-aldosterone system (RAAS) results in vasoconstriction, muscular (vascular and cardiac) hypertrophy and fibrosis. Established arterial stiffness and cardiac dysfunction are key factors contributing to subsequent cardiovascular and renal complications. Blockade of RAAS has been shown to be beneficial in patients with hypertension, acute myocardial infarction, chronic systolic heart failure, stroke and diabetic renal disease. An aggressive approach for more extensive RAAS blockade with combination of two commonly used RAAS blockers [ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)] yielded conflicting results in different patient populations. Combination therapy is also associated with more side effects, in particular hypotension, hyperkalaemia and renal impairment. Recently published ONTARGET study showed ACEI/ARB combination therapy was associated with more adverse effects without any increase in benefit. The Canadian Hypertension Education Program responded with a new warning: 'Do not use ACEI and ARB in combination'. However, the European Society of Cardiology in their updated heart failure treatment guidelines still recommended ACEI/ARB combo as a viable option. This apparent inconsistency among guidelines generates debate as to which approach of RAAS inhibition is the best. The current paper reviews the latest evidence of isolated ACEI or ARB use and their combination in cardiovascular diseases, and makes recommendations for their prescriptions in specific patient populations.

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Section: Combination Therapy Of Acei and Arbmentioning

confidence: 88%

Renin–angiotensin–aldosterone system blockade for cardiovascular diseases: current status

Terry

Kam

Yan

et al. 2010

British J Pharmacology

307

200

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“…In cases where infective endocarditis patients exhibit signs of secondary glomerular disease, such as proteinuria or rising creatinine, first-line treatment involves corticosteroid agents like prednisolone at immunosuppressing doses (e.g., 1 mg/kg/ day) to restrain inflammatory damage to the glomerular capillary units mediated by antibody binding, complement activation, and leukocyte influx [25]. Plasma exchange is a potent adjuvant therapy, directly eliminating circulating immune complexes and inflammatory mediators like cytokines, coagulation factors, and complement proteins [26].…”

Section: Prevention and Treatment Strategiesmentioning

confidence: 99%

Untitled

2019

GJPPS

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This article delves into the intricate landscape of glomerulonephritis secondary to acute endocarditis, a condition marked by the complex interplay of infectious, immunological, and renal factors. Addressing the evolving epidemiology and risk factors, it sheds light on the clinical manifestations that underscore the multifaceted nature of the disease. The diagnostic approach encompasses a comprehensive evaluation involving serological markers, blood cultures, and imaging studies, with renal biopsy crucial in assessing the severity of glomerular damage. The grim prognosis for renal function recovery necessitates nuanced therapeutic strategies, emphasizing the cautious use of immunosuppression and the importance of distinguishing this condition from other renal pathologies. The article highlights that a multidisciplinary approach involving cardiologists, infectious disease specialists, and nephrologists is paramount to developing tailored management plans. Exploring prevention and treatment strategies underscores the critical role of early initiation of pathogen-directed antibiotic therapy and vigilant monitoring for renal involvement. Ultimately, the article provides insights into the complexities of glomerulonephritis secondary to acute endocarditis, guiding early detection, prevention, and refined therapeutic interventions in this intricate intersection of infectious and renal pathology.

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“…Together, these data provide evidence regarding the involvement of the RAS in the progression of T1DM associated with hyperglycemia ( Figure 2). Pharmacological blockade of the RAS components through ACE inhibitors [11] and AT1 receptor antagonists [38] has been recommended as a therapeutic strategy to minimize the deleterious effects of diabetes by improving renal function (renal plasma flow and glomerular filtration) and cardiovascular function (increases in arterial compliance and endothelial function; reductions in arterial blood pressure) [39,40]. According to Oak and Cai [41], RAS downregulation significantly reduces the incidence of vascular complications of diabetes.…”

Section: Renin Angiotensin System and Progression Of T1dmmentioning

confidence: 99%

Complications of Type 1 Diabetes Mellitus are Associated with Renin Angiotensin System: The Role of Physical Exercise as Therapeutic Tool

Fiorino¹,

Evangelista²

2014

Pancreat Disord Ther

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Type 1 diabetes mellitus (T1DM) is associated with the development of severe complications including cardiovascular diseases, nephropathy, retinopathy and neuropathy. The peptide Angiotensin II (Ang II), the main effector molecule of the renin angiotensin system (RAS), has been widely investigated because it plays an important role in the pathogenesis of T1DM and evidence in the literature suggests the pharmacological blockade of the RAS components as a potential therapeutic strategy to minimize the deleterious effects of T1DM by improving metabolism control, renal and cardiovascular functions.Physical exercise can also contribute to avoid the complications of T1DM by enhancing metabolism of carbohydrates and lipids, peak oxygen consumption, vascular function, autonomic response and arterial blood pressure. Furthermore, the physical exercise is able to reduce the level of tissue RAS. Thus, part of the benefits of physical exercise for prevention and treatment of metabolic and cardiovascular diseases in T1DM may be mediated by the RAS. The present review aimed to discuss the evidence regarding the involvement of the RAS in the progression of T1DM, the relevance of physical exercise to the management of T1DM and the role of physical exercise to induce adaptations in the RAS.

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Renal effects of dual renin–angiotensin–aldosterone system blockade in patients with diabetic nephropathy

Cited by 11 publications

References 54 publications

Renin–angiotensin–aldosterone system blockade for cardiovascular diseases: current status

Renin–angiotensin–aldosterone system blockade for cardiovascular diseases: current status

Untitled

Complications of Type 1 Diabetes Mellitus are Associated with Renin Angiotensin System: The Role of Physical Exercise as Therapeutic Tool

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